Some antidepressants are also known to reduce sex drive. It’s important to ask patients if any medications might be interfering with their intimacy, because depression is frequent among RA patients, says Watkins.
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Explore This IssueJuly 2014
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Men with RA are more likely than those without to suffer from erectile dysfunction, says Shteynshlyuger. Oral PDE-5 inhibitors, such as Viagra and Cialis, work well in this population, he says.
Second-line treatments, such as self-injection with alprostadil or Trimix, and vacuum erection devices “tend not to work, due to limitations with manual dexterity,” Shteynshlyuger says. “Inflatable penile prosthesis, while ideal for most men, require fine dexterity skills, and may not work well in [men with rheumatoid conditions]. In these men, semi-rigid penile prosthesis, which requires minimal and only coarse dexterity, offers an effective and satisfactory treatment option.”
Advice for Patients
In her quest to improve her own sex life, Leach writes, “I forced myself to read more than 50 articles about sex and RA!” (italics hers). These were mostly popular articles she found by Google search, from such websites as WebMD and HealthCentral, as well as websites directed toward life with arthritis, such as Arthritis Today and the ACR. “The vast majority of the articles” provided a mostly grim view of RA patients’ prospects for sex, she says, but she culled the small percentage of the information that addressed what patients can actually do to improve their sex lives, first for herself, and then in a detailed blog post on a website for rheumatology patients. The experts interviewed by The Rheumatologist independently made many of the same points. The highlights should provide guidance to rheumatologists for addressing sexual issues:
Sex is not just intercourse. Sex offers plenty of pleasurable activities for those for whom intercourse is difficult or unappealing, including “fantasizing together … visual stimulation, … hugging, cuddling, kissing, sensual massage, oral contact … and fondling,” Leach writes. She advises readers to “be creative in finding other ways to improve your emotional and physical connection with your partner.”
Lynn notes that even among couples for whom intercourse is often successful, finding the right position “may be a work in progress,” because change is a constant for patients.
Work on your relationship. Leach stresses the need for “open and honest communication,” noting, “It may be easier to invite dialogue with your partner if you begin sentences with ‘I’ rather than ‘you.’ For example, ‘I feel loved when you hold me close’ is probably better than ‘you never touch me anymore,’” she writes.